The fight for women’s equality in the western world dates back to the early 1830s when the suffragettes began demanding the right to vote. After the Second World War, a second wave of feminism brought about many societal changes. The current third wave is fighting for more nebulous goals. Women, themselves, medical organizations, and current medical leaders all have a role to play in recognizing, encouraging, and facilitating leadership among women.

Feminism is the modern term for the underlying force that is driving the slow recognition that all women and men are equally valuable to society. The word feminism is relatively new and has supplanted suffrage and women’s liberation over the past 100 years as the waves of fighting for equal value have rolled over the western world.

The fight for women’s equality in the western world dates back to the early 1830s when the suffragettes began demanding the right to vote. Five Albertan women led by Judge Emily Murphy brought the “persons case” to the Supreme Court of Canada. The group, known as the Famous Five, included Irene Parlby, Henrietta Edwards, Nelly McClung, and Louise Crummy McKinley. The case was preceded by years of activism and, in 1927, the Supreme Court decided that women in Canada were persons and, therefore, had the right to vote. Provincially, the struggle was slower, with Inuit and First Nations women winning the right to vote only in 1961. In 2000, the Canadian government dedicated two statues to the Famous Five, one in Calgary and one in Ottawa, both called “Women Are Persons!”1

After the Second World War, many groups came together to fight for their civil rights, including women, African Americans, and the LGBT community. From the 1960s to the 80s, women were arguing for reproductive rights, the right to equal pay for equal work, the right to own property, the right to go to professional schools, the right to apply to any job, the right to charge their husbands with rape. This “second wave” of feminism is the one in which I, as a product of the Baby Boom, was first involved, although we did not call ourselves feminists then; we called what we were doing “women’s liberation” or “women’s lib.” Top

As part of a women’s lib group in the 70s and 80s, colleagues and I discussed and railed at differences in how men and women were treated, including my own experience in a pre-med biology class at the University of Alberta. All students were mandated to meet one-to-one with the male professor, who asked me, “If you get into medicine, how will that conflict with your duty to have children?” I can’t recall what I said in return; I likely made something up to satisfy him, not knowing whether he had any sway over medical school admissions. Back in class, this certainly was a topic of discussion as we discovered that the men in the class had not been asked any questions about their “duty” to have children.

The Canadian Medical Association reports that, in 2017, 58% of first-year medical students were women.2 This is in contrast to many years of quotas for women in professional schools.

“Women were generally unwelcome in professional programs; as one medical school dean declared, ‘Hell yes, we have a quota.... We do keep women out, when we can. We don’t want them here’ — and they don’t want them elsewhere, either, whether or not they’ll admit it.”3

In 1970, the report of the Royal Commission on the Status of Women was tabled in parliament. 4 In 1971, a minister was appointed and a government ministry established in 1976.

The second wave of feminism led to many societal changes including the right for women to have an abortion, the right to divorce, and the right to hold men legally accountable for sexually assaulting their wives. There are numerous women’s health initiatives, research into women’s health, and women’s health centres as a result of the work done by second-wave feminists.

The journey to equality has been of the two steps forward, one step back variety, with each wave of momentum leading to a backlash. After women were declared persons whose votes counted as equal to men’s, the general worry was that women would begin demanding other rights of equality. As this did indeed occur, the concepts of “token female,” “quotas for women,” and “affirmative action” began to appear. Both the backlash to the first wave and the success of the second wave of feminism have had effects on women in medicine, the most visible being quotas on admissions giving way to equity of admission over time.

The backlash to the second wave in conjunction with feminisms’ third wave is producing the current complexities in our society. Speculations regarding the reasons behind the current backlash are many and include:

Women are not fighting for something concrete now — such as, the vote or the right to divorce — which makes the goal nebulous, more difficult to articulate and achieve in any linear fashion. Women today are fighting for gender equality, which doesn’t mean treating everyone the same, but rather treating people equitably so that everyone has an equal chance at success. Top

There is a contradiction between “cool feminism” and actual feminism. Cool feminism shows up on T-shirts, coffee mugs, posters, and in the form of celebrities. It seems that if a female celebrity says “this is a feminist thing to do” then it is accepted as such. Actual feminism — the movement to tackle the cultural institutions where men are valued over women — is not cool. It scares people, as change always scares people.

Feminism is more intersectional now, with the recognition that people are more than one identity at a time. Women can be transgendered, black, disabled feminists for example.5-8

Women themselves — particularly white, heteronormative women of privilege — have been criticized for behaving just like men once they are inside the institutions they previously criticized. Women of other races and women who are not heteronormative observe that they have been left out of the feminist narrative altogether.7

Inside the institutions of medicine today, both the wave of forward momentum and its backlash are visible. Although women are allowed at every level of medical hierarchy, they are not equally represented. Meritocracy is touted as the way things are done, and yet the numbers of medical women in positions of power does not provide evidence for the claim. White women of privilege are not equally represented in medical echelons, and there are even fewer women of minority groups.

Crispin6 argues that some women will not openly own up to being feminists for fear of making men uncomfortable. She states baldly that men’s discomfort is not women’s problem. She calls on men to self-examine their beliefs, feel the discomfort they have when they hear what other men do to women or say about women, and do their own work. “Do not ask women to reassure you that you are one of the good ones. This is manipulative.” Men will have to feel uncomfortable if they are to break through all of the messages they have been indoctrinated with through their lives.

In contrast, using 2012 data from the Pew Research Centre, Pinker9 makes the argument that the attitude toward women in America has changed since 1985. In that year, over 50% of Americans agreed with the statement “Women should return to their traditional roles in society” compared with 25% in 2012. And there is a steady downward trend in that thinking. In a fascinating chart, Pinker uses data from Google that show another downward trend since 2004: the number of searches for sexist, racist, and homophobic jokes. Pinker also makes the point that millennials value human equality more highly than any other generation, that people tend to carry their values with them throughout their life and so, by the time millennials are ruling the world, corporate boards and medical advisory committees will look a lot more balanced. At least in America.

Although Pinker’s9 book is reassuring that the world as a whole is headed in the right direction, it is equally clear that misogyny still exists. In the democratic countries, the #metoo and #timesup movements have started to have an impact in the entertainment, educational, and corporate domains. Only 22.8% of all national parliamentarians were women in 201610; 95.2% of Fortune 500 companies have male CEOs.11 “Men are able to pursue a meaningful career without others questioning their familial love. Men have the power to voice their opinions in a direct manner without fear of dissent. Men have the ability to wear what they want without doubt or harassment.”5 Top

As the women who entered medical school in 2017 age, the demographics of physicians in general will change in Canada from the current balance of 38% women to more than half. And what of physician leaders? The topic of women leaders in Canadian health care is woefully under-researched; however, in one Ottawa study, although staff included 30% women physicians, only 13% of physician leaders were women.12

“A similar situation is found in medical schools, where women comprise 50% or more of medical school graduates, but only 13–15% of department chairs in the USA and Canada.”12

In a rare Canadian research article into the underlying reasons women give for their exclusion from medical leadership, Virginia Roth and her colleagues12 highlight three themes: individual factors; organizational factors; and leadership support, development, and systemic correctives. This study suggests potential opportunities for action in all three areas.

Women, individually, could work on their own mindsets about what it means to be a medical leader and adjust their self-concepts to recognize their own leadership potential.

Medical organizations could take action in the selection and hiring of physician leaders through transparent and gender-equal or even female-biased selection committees. They could ensure leader role descriptions recognize the need for work–life balance, especially when leaders (men and women) are in their child-raising years.

Medical leaders could use one-to-one time with their direct reports to assess both women’s and men’s strengths and interest in leadership, create more transparency regarding the roles leaders play, and coach or mentor those interested in moving forward regardless of gender.

By 2030, most working physicians in Canada will be women. It will be fascinating to see how the culture of medicine changes as we reach this tipping point. Many of these women will be aware of the fight for equity that has preceded them, and changes to the gender balance in physician leadership should ensue. Increasing our efforts at inclusion of marginalized women as well as white women over the next 10 years would stand us in good stead for the future.

The second wave of feminism led to many societal changes including the right for women to have an abortion, the right to divorce, and the right to hold men legally accountable for sexually assaulting their wives. There are numerous women’s health initiatives, research into women’s health, and women’s health centres as a result of the work done by second-wave feminists.

The fight for women’s equality in the western world dates back to the early 1830s when the suffragettes began demanding the right to vote. After the Second World War, a second wave of feminism brought about many societal changes. The current third wave is fighting for more nebulous goals. Women, themselves, medical organizations, and current medical leaders all have a role to play in recognizing, encouraging, and facilitating leadership among women.

Feminism is the modern term for the underlying force that is driving the slow recognition that all women and men are equally valuable to society. The word feminism is relatively new and has supplanted suffrage and women’s liberation over the past 100 years as the waves of fighting for equal value have rolled over the western world.

The fight for women’s equality in the western world dates back to the early 1830s when the suffragettes began demanding the right to vote. Five Albertan women led by Judge Emily Murphy brought the “persons case” to the Supreme Court of Canada. The group, known as the Famous Five, included Irene Parlby, Henrietta Edwards, Nelly McClung, and Louise Crummy McKinley. The case was preceded by years of activism and, in 1927, the Supreme Court decided that women in Canada were persons and, therefore, had the right to vote. Provincially, the struggle was slower, with Inuit and First Nations women winning the right to vote only in 1961. In 2000, the Canadian government dedicated two statues to the Famous Five, one in Calgary and one in Ottawa, both called “Women Are Persons!”1

After the Second World War, many groups came together to fight for their civil rights, including women, African Americans, and the LGBT community. From the 1960s to the 80s, women were arguing for reproductive rights, the right to equal pay for equal work, the right to own property, the right to go to professional schools, the right to apply to any job, the right to charge their husbands with rape. This “second wave” of feminism is the one in which I, as a product of the Baby Boom, was first involved, although we did not call ourselves feminists then; we called what we were doing “women’s liberation” or “women’s lib.” Top

As part of a women’s lib group in the 70s and 80s, colleagues and I discussed and railed at differences in how men and women were treated, including my own experience in a pre-med biology class at the University of Alberta. All students were mandated to meet one-to-one with the male professor, who asked me, “If you get into medicine, how will that conflict with your duty to have children?” I can’t recall what I said in return; I likely made something up to satisfy him, not knowing whether he had any sway over medical school admissions. Back in class, this certainly was a topic of discussion as we discovered that the men in the class had not been asked any questions about their “duty” to have children.

The Canadian Medical Association reports that, in 2017, 58% of first-year medical students were women.2 This is in contrast to many years of quotas for women in professional schools.

“Women were generally unwelcome in professional programs; as one medical school dean declared, ‘Hell yes, we have a quota.... We do keep women out, when we can. We don’t want them here’ — and they don’t want them elsewhere, either, whether or not they’ll admit it.”3

In 1970, the report of the Royal Commission on the Status of Women was tabled in parliament. 4 In 1971, a minister was appointed and a government ministry established in 1976.

The second wave of feminism led to many societal changes including the right for women to have an abortion, the right to divorce, and the right to hold men legally accountable for sexually assaulting their wives. There are numerous women’s health initiatives, research into women’s health, and women’s health centres as a result of the work done by second-wave feminists.

The journey to equality has been of the two steps forward, one step back variety, with each wave of momentum leading to a backlash. After women were declared persons whose votes counted as equal to men’s, the general worry was that women would begin demanding other rights of equality. As this did indeed occur, the concepts of “token female,” “quotas for women,” and “affirmative action” began to appear. Both the backlash to the first wave and the success of the second wave of feminism have had effects on women in medicine, the most visible being quotas on admissions giving way to equity of admission over time.

The backlash to the second wave in conjunction with feminisms’ third wave is producing the current complexities in our society. Speculations regarding the reasons behind the current backlash are many and include:

Women are not fighting for something concrete now — such as, the vote or the right to divorce — which makes the goal nebulous, more difficult to articulate and achieve in any linear fashion. Women today are fighting for gender equality, which doesn’t mean treating everyone the same, but rather treating people equitably so that everyone has an equal chance at success. Top

There is a contradiction between “cool feminism” and actual feminism. Cool feminism shows up on T-shirts, coffee mugs, posters, and in the form of celebrities. It seems that if a female celebrity says “this is a feminist thing to do” then it is accepted as such. Actual feminism — the movement to tackle the cultural institutions where men are valued over women — is not cool. It scares people, as change always scares people.

Feminism is more intersectional now, with the recognition that people are more than one identity at a time. Women can be transgendered, black, disabled feminists for example.5-8

Women themselves — particularly white, heteronormative women of privilege — have been criticized for behaving just like men once they are inside the institutions they previously criticized. Women of other races and women who are not heteronormative observe that they have been left out of the feminist narrative altogether.7

Inside the institutions of medicine today, both the wave of forward momentum and its backlash are visible. Although women are allowed at every level of medical hierarchy, they are not equally represented. Meritocracy is touted as the way things are done, and yet the numbers of medical women in positions of power does not provide evidence for the claim. White women of privilege are not equally represented in medical echelons, and there are even fewer women of minority groups.

Crispin6 argues that some women will not openly own up to being feminists for fear of making men uncomfortable. She states baldly that men’s discomfort is not women’s problem. She calls on men to self-examine their beliefs, feel the discomfort they have when they hear what other men do to women or say about women, and do their own work. “Do not ask women to reassure you that you are one of the good ones. This is manipulative.” Men will have to feel uncomfortable if they are to break through all of the messages they have been indoctrinated with through their lives.

In contrast, using 2012 data from the Pew Research Centre, Pinker9 makes the argument that the attitude toward women in America has changed since 1985. In that year, over 50% of Americans agreed with the statement “Women should return to their traditional roles in society” compared with 25% in 2012. And there is a steady downward trend in that thinking. In a fascinating chart, Pinker uses data from Google that show another downward trend since 2004: the number of searches for sexist, racist, and homophobic jokes. Pinker also makes the point that millennials value human equality more highly than any other generation, that people tend to carry their values with them throughout their life and so, by the time millennials are ruling the world, corporate boards and medical advisory committees will look a lot more balanced. At least in America.

Although Pinker’s9 book is reassuring that the world as a whole is headed in the right direction, it is equally clear that misogyny still exists. In the democratic countries, the #metoo and #timesup movements have started to have an impact in the entertainment, educational, and corporate domains. Only 22.8% of all national parliamentarians were women in 201610; 95.2% of Fortune 500 companies have male CEOs.11 “Men are able to pursue a meaningful career without others questioning their familial love. Men have the power to voice their opinions in a direct manner without fear of dissent. Men have the ability to wear what they want without doubt or harassment.”5 Top

As the women who entered medical school in 2017 age, the demographics of physicians in general will change in Canada from the current balance of 38% women to more than half. And what of physician leaders? The topic of women leaders in Canadian health care is woefully under-researched; however, in one Ottawa study, although staff included 30% women physicians, only 13% of physician leaders were women.12

“A similar situation is found in medical schools, where women comprise 50% or more of medical school graduates, but only 13–15% of department chairs in the USA and Canada.”12

In a rare Canadian research article into the underlying reasons women give for their exclusion from medical leadership, Virginia Roth and her colleagues12 highlight three themes: individual factors; organizational factors; and leadership support, development, and systemic correctives. This study suggests potential opportunities for action in all three areas.

Women, individually, could work on their own mindsets about what it means to be a medical leader and adjust their self-concepts to recognize their own leadership potential.

Medical organizations could take action in the selection and hiring of physician leaders through transparent and gender-equal or even female-biased selection committees. They could ensure leader role descriptions recognize the need for work–life balance, especially when leaders (men and women) are in their child-raising years.

Medical leaders could use one-to-one time with their direct reports to assess both women’s and men’s strengths and interest in leadership, create more transparency regarding the roles leaders play, and coach or mentor those interested in moving forward regardless of gender.

By 2030, most working physicians in Canada will be women. It will be fascinating to see how the culture of medicine changes as we reach this tipping point. Many of these women will be aware of the fight for equity that has preceded them, and changes to the gender balance in physician leadership should ensue. Increasing our efforts at inclusion of marginalized women as well as white women over the next 10 years would stand us in good stead for the future.